The NEJM as a tabloid

At what cost do political machinations of the medical journals come? NEJM editors have long favored more drug regulation. But medical journals have also historically played a special role in helping to define medical practice standards. Even decisions they make on how prominently to place a study, let alone how they editorialize about it, are seen as strong signals to clinicians on how doctors should weigh the evidence. So when editors pursue a political agenda, it’s public health that pays a price. Degrading an institution that doctors depend on for balanced analysis and fair-minded editorial judgments isn’t good for anyone.

In the case of the Avandia study, NEJM editors gave short shrift to the study’s flaws. The paper, which re-analyzed the results of 42 earlier studies of the drug found on the Internet, revealed that Avandia might cause a small increase in the absolute risk of a heart attack. But the study that the authors did, called a “meta-analysis” because it aggregates results from lots of studies to generate a larger sample, contained a number of serious limitations.